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SEOM clinical guidelines for the treatment of osteosarcoma in adults-2013

Abstract

The diagnosis and treatment of osteosarcoma should be performed by an experienced multidisciplinary team. Considering it is a systemic disease, chemotherapy is essential for long-term success. The drugs most commonly used are: cisplatin, adriamycin, high-dose methotrexate, ifosfamide, etoposide, and, more recently, mifamurtide. The neoadjuvant chemotherapy allows to know tumour chemosensitivity and getting the main prognostic factor: the percentage of tumour necrosis. In addition to chemotherapy, it is important to conduct surgical resection of primary tumour with wide margins, and in disseminated disease also to attempt resection of pulmonary metastasis.

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References

  1. Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the surveillance, epidemiology, and end results program. Cancer. 2009;115(7):1531–43.

    Article  PubMed  Google Scholar 

  2. Wittig JC, Bickels J, Prebat D, Jelinek J, Kellar-Graney K, Shmookler B, et al. Osteosarcoma: a multidisciplinary approach to diagnosis and treatment. Am Fam Physician. 2002;65:1123–32.

    PubMed  Google Scholar 

  3. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop. 1980;153:106–20.

    PubMed  Google Scholar 

  4. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, et al. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–90.

    Article  PubMed  Google Scholar 

  5. Hogerndoorn PCW. Bone sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;5:v204–13.

    Article  Google Scholar 

  6. Link MP, Goorin AM, Miser AW, Green AA, Pratt CB, Belasco JB, et al. The effect of adjuvant chemotherapy on relapse-free survival in patients with osteosarcoma of the extremity. N Engl J Med. 1986;314(25):1600–6.

    Article  PubMed  CAS  Google Scholar 

  7. Meyers PA, Schwartz CL, Krailo MD, Healey JH, Bernstein ML, Betcher D, et al. Osteosarcoma: the addition of muramyl tripeptide to chemotherapy improves overall survival––a report from the children’s oncology group. J Clin Oncol. 2008;26(4):633–8.

    Article  PubMed  CAS  Google Scholar 

  8. Ferrari S, Ruggieri P, Cefalo G, Tamburini A, Capanna R, Fagioli F, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in non-metastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol. 2012;30(17):2112–8.

    Article  PubMed  CAS  Google Scholar 

  9. Bacci G, Picci P, Ferrari S, Ruggieri P, Casadei R, Tienghi A, et al. Primary chemotherapy and delayed surgery for non metastatic osteosarcoma of the extremities. Results in 164 patients preoperatively treated with high doses of methotrexate followed by cisplatin and doxorubicin. Cancer. 1993;72(11):3227–38.

    Article  PubMed  CAS  Google Scholar 

  10. Winkler K, Beron G, Delling G, Heise U, Kabisch H, Purfürst C, et al. Neoadjuvant chemotherapy of osteosarcoma: results of a randomized cooperative trial (COSS-82) with salvage chemotherapy based on histological tumor response. J Clin Oncol. 1988;6(2):329–37.

    PubMed  CAS  Google Scholar 

  11. Bacci G, Rocca M, Salone M, Balladelli A, Ferrari S, Palmerini E, et al. High grade osteosarcoma of the extremities with lung metastases at presentation: treatment with neoadjuvant chemotherapy and simultaneous resection of primary and metastatic lesions. J Surg Oncol. 2008;98(6):415.

    Article  PubMed  Google Scholar 

  12. Kager L, Zoubek A, Potschger U, Kastner U, Flege S, Kempf-Bielack B, et al. Primary metastatic osteosarcoma: presentation and outcome of patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2003;21:2011–8.

    Article  PubMed  Google Scholar 

  13. Mineo TC, Ambrogi V, Pompeo E, Nofroni I. The value of the Nd:YAG laser for the surgery of lung metastases in a randomized trial. Chest. 1998;113:1402–7.

    Article  PubMed  CAS  Google Scholar 

  14. Gentet JC, Brunat-Mentigny M, Demaille MC, Pein F, Avet-Loiseau H, Berger C, et al. Ifosfamide and etoposide in childhood osteosarcoma. A phase II study of the French society of paediatric oncology. Eur J Can. 1997;33(2):232–7.

    Article  CAS  Google Scholar 

  15. Navid F, Willert JR, McCarville MB, Furman W, Watkins A, Roberts W, et al. Combination of gemcitabine and docetaxel in the treatment of children and young adults with refractory bone sarcoma. Cancer. 2008;113:419–25.

    Article  PubMed  CAS  Google Scholar 

  16. Saylors RL III, Stine KC, Sullivan J, Kepner JL, Wall DA, Bernstein ML, et al. Cyclophosphamide plus topotecan in children with recurrent or refractory solid tumors: a paediatric oncology group phase II study. J Clin Oncol. 2001;19:3463–9.

    PubMed  CAS  Google Scholar 

  17. Chawla SP, Staddon AP, Baker LH, Schuetze SM, Tolcher AW, D’Amato GZ, et al. Phase II study of the mammalian target of rapamycin inhibitor ridaforolimus in patients with advanced bone and soft tissue sarcomas. J Clin Oncol. 2012;30(1):78–84.

    Article  PubMed  CAS  Google Scholar 

  18. Grignani G, Palmerini E, Dileo P, Asaftei SD, D’Ambrosio L, Pignochino Y, et al. A phase II trial of sorafenib in relapsed and un resectable high-grade osteosarcoma after failure of standard multimodal therapy: an Italian sarcoma group study. Ann Oncol. 2012;23(2):508–16.

    Article  PubMed  CAS  Google Scholar 

  19. Bielack SS, Kempf-Bielack B, Heise U, Schwenzer D, Winkler K, et al. Combined modality treatment for osteosarcoma occurring as a second malignant disease. J Clin Oncol. 1999;17:1164–74.

    PubMed  CAS  Google Scholar 

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The authors declare that they have no conflict of interest relating to the publication of this manuscript.

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Correspondence to A. Redondo.

Appendix: Clinical Guideline Working Group on behalf of the Spanish Society of Medical Oncology (SEOM) Executive Committee 2011–2013

Appendix: Clinical Guideline Working Group on behalf of the Spanish Society of Medical Oncology (SEOM) Executive Committee 2011–2013

Juan Jesús Cruz, Pilar Garrido, Agustí Barnadas, Pablo Borrega, Francisco Javier Barón, Elvira del Barco, Rocio García-Carbonero, Jesús Garcia-Mata, Encarnación Gonzalez, Pilar Lianes, Antonio Llombart y Fernando Rivera.

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Redondo, A., Cruz, J., Lopez-Pousa, A. et al. SEOM clinical guidelines for the treatment of osteosarcoma in adults-2013. Clin Transl Oncol 15, 1037–1043 (2013). https://doi.org/10.1007/s12094-013-1087-0

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  • DOI: https://doi.org/10.1007/s12094-013-1087-0

Keywords

  • Osteosarcoma
  • Diagnosis
  • Chemotherapy
  • Surgery
  • Mifamurtide
  • Multidisciplinary team